Cognitive Behavior Perspective In Nursing Practices

Psychology is the scientific study of behavior and mental processes. Anything, we do like eating, hanging out, sleeping, talking, sneezing is referring as behavior. Evidently, people are interested in actions and response which are observable called as overt behavior but the psychologists usually study about covert behavior refer as internal activities such as dreaming, remembering, and other mental events (Jackson, 2008). This clarifies that psychology is based on cognitive behavior. According to oxford dictionary cognition means “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.” and behavior “is the way in which one acts or conducts oneself.”

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Nursing is a profession with incorporate holistic care and provide a guide to the knowledge; skills, judgment & attitude to practice safely and nurses spent their time in interacting with people. Most Important part of their job is to promote awareness of well being and Nurses are responsible for the regularly supervising and managing quality of health care provided to clients. Roles of nurse consist of immediate notice and apply intervention when clients condition changes. Professional nursing practices require not only affective skills, but complex thinking processes such as making inference and combining the information to select an intervention. Nurses make up the inspection system for early finding of clients problems or complications, and timely initiate measures or interventions that reduce client’s negative outcomes. The major aims of those who are involved in health care require knowledge and skills to facilitate clients. Cognitive behavior contributes in enhancement of health care. On the whole cognition is a significant feature in nursing practices which helps nurse and client to think critically and rationally and also contribute in enhancement of communication or therapeutic relationship and understating the client’s behavior in terms of cognitive behavior perspective.

Nowadays, psychology is applied to solve problems in mental health, education, business, sports, law and medicine (Coolican et al., 2007). So mental capability which is required in various setting including medical profession are come as whole in cognitive behavior and it is based on the ways in which people organized and process relevant information in particular setting. According to Piaget, cognitive development refers to changes and stability in mental abilities, such as language, thinking, learning, memory, and reasoning. He used a term schemes means schemes are mental processes and actions that organized knowledge (Papalia et al., 2007). For examples we experiences atypical behaviors like phobias, we feel anxiety at that time and behavior could be avoidance. This clarify the relation among cognition and behavior in addition to this there are numerous aspects come under the umbrella of cognition like decision making, logical thinking, and perception. Basically Cognition indicate how individual process information mentally and how our thoughts acquire several forms; consist of problem solving, reasoning and dreaming. At its most basic, internal or mental representation of a situation or problem is expressed as thinking. It could be practically applied in nursing practices, while performing canulation or any other skills nurses used mental image firstly to think what is required, like equipments which is necessary during canulation and position of patient and nurse, after that remember his/her previous experiences of performing canulation or had any incident, lastly analytical approach like in past any bad event occur then this time she/he will try to perform in safer technique or request any colleague to perform and if the event was in safe hands than she/he will try to continue it. In this way while performing any activity our physical actions as well as mental ability are involved. A further vital approach which nurses have to use in every day situation is problem solving. Problem solving can be as common approach in nursing profession that how nurses will respond to cancer patient about his medical diagnose; if family says not to tell, circumstances similar to this, will engage nurses to think logically and respond to the situation and here another point arise which is ethical dilemma comes tell or not to tell the patient. Each and every aspect is based on cognitive ability, functioning of individual or people.

Moreover, therapy which enlightens both cognitive and behavior aspect is called as cognitive behavior therapy (CBT). Cognitive behavior therapy is a psychological treatment that deal with interactions between how we believe, experience (cognitive) and conduct your self (behavior). In various mental disorders cognition of person gets impaired for example according to research (Cognition & Emotion Metha, 2012) depression symptoms show evidence of deficit in emotional responsively, and other disorders are schizophrenia, personality disorder in which patient experience delusions, hallucinations, memory impairment, concrete thinking, impaired judgment and perception and other cognitive functions. Basically cognitive behavior therapy focused, collaborative, structured and usually short-term therapy that seeks to facilitate problem solving or decision making and to modify unusual thoughts and behavior.

Cognitive behavior therapy has a view of life which focuses on five key areas: thoughts, behavior, emotion/mood, physiological responses and environmental (Greenberger & Padesky 1995). These all aspects of life are influenced by environment; it could be social or physical environment. So change in any of the above factor may cause improvement or further worsening in other factors. It observed in clinical setting at psychiatric ward all the patient were asked to move toward to garden where they have to perform exercise, so while performing the exercises some of them where feeling better and some where feeling anxious which comes under mood and performing exercise is behavior of the patients, while performing they experienced increase heart rate and sweating it is a physiological reaction and the garden is the environment under which they where performing action. So through this observation we can state that all the factors influence each other while performing any action.

One of the approach in cognitive behavior therapy is cognitive approach which refer to how people thinks, process and create sense about situation, warning sign and events in their lives and how they develop views about themselves, other and the world. The techniques used in cognitive therapy helps people to become aware of how they rationalized, and which kind of thoughts that arise in brain and give meaning to things (Grazebrook & Garland 2005). As seem in a clinical setting, when patient conditions get worse or deteriorate like high grade fever so nurse firstly evaluate patients status by using his/her thinking process and judgmental ability, after assessing the thoughts springs up in mind to applied knowledge in a logical way or perform intervention to improve condition of patient which could be tepid sponge or shower and reassess temperature, if he/she encounter any serious problem like cardiac arrest or if patient gets unconscious so he/she will immediately inform other health care team members and initiate the intervention accordingly. So we can say that while performing task our mind begin thinking logically and rationally and act accordingly.

Furthermore there are three levels of cognition that are amenable to therapeutic intervention (Beck et al 1979 cited in book of creek & laugher 2008). The levels are arranged in nature of a hierarchy order with automatic thoughts, beliefs and core schema. Let’s discuss it one by one, automatic thoughts it can be called as uninvited thoughts that suddenly comes into your mind. For examples, ‘when a nursing student make an teaching plan and faculty ask that this not a proper plan and she rejects, so the automatic thoughts pop up in mind was, ‘the plan which is prepared by me is always worthless’. These occur rapidly in response to circumstances and without rational analysis (Townsend, 2006). Another level is beliefs, which we hold about ourselves and to certain extent it influences our behavior like according to above example nursing student may thinks that, ‘if I can’t create a proper teaching plan so there’s no point of doing it at all’. Third level is core schema, absolute core of beliefs, we believe about ourselves. If we consider above example so the nursing student may judge that, ‘I am useless’ Schemas developed by the influenced of pervious experiences. Core schema develops beliefs and from beliefs, automatic thoughts come. Superficial levels of cognition are focused in CBT and these are enough for symptomatic relief of recent problem. According to a research done on severe malaria patient’s (Bangirana et al., 2011) concluded that cognitive intervention improve some of the cognitive abilities in three months. However in the same research, researcher also state that there is no improvement observed in academic skills and behavior within three months of their research time period. But in another research on obesity (Reever, 2008) stated that behavioral management plays vital role in weight loss. So researches, explain their perspective but we conclude that behavior and cognitive both have their own significant in the therapy.

Behavior is how a person response or react and manner of behaving or conducting oneself. Skinner (1904-1990) enlightens behavior as overt behavior (responses) to observable events in the environment (stimulus) thus called stimulus-response connection. (Domjan, 2006) stated that permanent change in behavior due to experience is called as learning. The behaviorist put emphasis on changes in behaviors is due to influence and control of the outside environment, rather than inside thought process of the people (Merriam & Caffarella, 1999). Success in social situation may also input in developing self-esteem and focusing on performing activities.

An additional in cognitive behavior therapy has behavioral approach, it refers to the ways in which people react or respond to the situations and their responses could be reducing that action or avoidance. Behavioral approach take on development of particular forms of behavior that lead to more general change in the way the people identify himself and the actual world (Grazebrook & Garland 2005) and according to Vygotsky, social interactions helps in cognitive development. Once in clinical setting a patient diagnose with personality disorder stated that he is feeling better in his condition internally while playing games together with other patient in garden area also said that environment is very good and nurses also observed improvement in his behavior. This statement and overt behavior of a mentally ill patient clearly justify the point of Merriam & Caffarella and Vygotsky that social interaction and external environment influences person behavior, positive or negative changes in behavior is because of the influence of change in external environment. There are many disorders in which behavior changes observed like Obsessive Compulsive disorder, Schizophrenia, Mood Disorders, depression and a lot more. Therefore Cognitive behavior therapy focuses on performing activities and boost up self esteem of the person so that they can faced the world and not get socially isolated.

Major goals of cognitive behavior therapy is to help people to study behavior and new ways to coping with events, connection between thinking, feeling and behaviors, identify alter dysfunctional beliefs that lead to maladaptive behavior, substitute more realistic analysis for distorted thoughts and feel safe enough too progressively change their behavior. This might will help the people to face their feared or avoided situation so their anxiety gets reduced and people learn how to deal with problems.

In conclusion, cognitive behavior approaches in therapy is to aim directly target response and thinking ability and reduce distress and improve or promote helpful behavioral responses. Person’s Cognitive ability is influenced by external environment and previous experiences and it is clearly observed in responses or reaction of a person towards the situation. While dealing with the situation person uses his mental ability and react accordingly. Nurses as a health care member are also involved in cognitive behavioral perspective in clinical setting. Nurse work collaboratively with other health care team member and facilitate modification in thoughts, perceptions, beliefs and reactions to events of client and issues like decision making, assess clients condition by use critical thinking and reporting it timely are also involved in cognitive behavioral approach. Nurses use this approach to satisfy client and critically perform their duties. And behavior and cognitive therapy helps client to improve their physical as well as mental condition.

Paul Bangirana1,2*, Peter Allebeck2, Michael J Boivin3,4, Chandy C John5, Connie Page6, Anna Ehnvall7,8 and

Seggane Musisi1

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Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial

Cognitive-Behavioral Interventions for Obesity




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